I took this commentary from a conversation I had with some friends in a blog. These are solely my opinions of course, but I leave this topic open for discussion.

I will put my comments in plain text, with comments from speaker one in red text and comments from speaker two in blue text. The writer in the blue text has recently graduated from medical school. I was thoroughly disappointed and disheartened that she had the opinions that she did since they seemed so pessimistic - but I keep an open mind that I might be looking at this topic the wrong way.

Comments:

I say: less money on cancer cure, and more on cancer prevention. My guess is that there would be an awful lot less cancer.

I think we all have a diathesis and with enough environmental stressors, we would all get cancer or a host of other chronic diseases. Some people, like my grandfather, have been perpetually drunk for over 50 years and still in (what appears to be) perfect health. As resilient as human bodies are, I can't imagine this can go on much longer for him. Others lead healthy lives and get cancer very young. How sad and unfair. :-(

So a good idea would be to limit stressors as much as possible. Some would still get cancer, but that would be genetic and very difficult to avoid, regardless of preventative measures. Instead, everyone thinks health is simply the absence of disease and everything can be cured with a pill or a needle. As soon as this attitude changes, the better it will be for everyone.

/opinion>

The problem is the cases of cancer that develop from what appears to be nowhere. It's all well and good to talk about limiting cancer stressors, and trying to prevent it is a good idea in theory, but there are inumerable things that contribute to cancer lately. Carsinogens are everywhere, so unless we make a drastic shift in the way we live, we're pretty much screwed.

The main problem with prevention models is that they assume we know everything that we have to prevent. I know we don't, and it's for that reason that cures are also important.

There is some interesting research going on right now in the field of gerontology regarding longevity, and apparently, people in the USA have the genetics coupled with environment required to live until the age of 87.

Even with all the cures in the world, I wonder if our lifespans would ever get that high? All the hopes and dreams people have of the benefits cures will bring them - a lot of these benefits can be ours right now if only we choose to tap into them. At the same time, that might lead to a boring existence. My post is obviously wishful thinking, but as inumberable as cancer causing agents may be, prevention is still extremely important.

I think that we're pretty much screwed whether we make a drastic shift or not, since the number of unknown carcinogens far outnumbers the known ones. It's hard to make drastic shifts when you don't know what you are shifting from really.

What both of you say sort of reminds me of the person who says he will smoke two packs a day and drink every night and never exercise or eat properly because "What's the use anyway? I know of a health freak who died of a heart attack at age 35."

The correlations between poor diet and lifestyle and chronic disease is far, far too strong for me to pretend cancer is just some random shot in the dark in every single case - yes it obviously is for a minority of individuals, but for many, the pathology can be clearly traced.

Not sure if either of you two go to bars often, but you really have to see how horrible some people live in order to believe it. My grandfather isn't the only 67 year old in this country who has always had a bottle or a pack of cigarettes by his side. Most of their names appear in obituaries instead of livejournals though.

Genetic anoJaneies exist though - you have health freaks dying young and neglectful people living until an old age - but surely these are the outliers.

My previous optometrist told me this "Physiologically we are product of our lifestyles 20 years ago."

I would tend to agree.

That having been said, my uncle recently called cancer "a disgusting disease" because some people get it out of nowhere. I recognize that cases like that do take place - but just because there is a lot about cancer we don't know, doesn't mean there isn't a lot we do know.

What I'm saying is that I'm going to try my best to lead a healthy lifestyle and get regular medical checkups, and my genetics will do the rest. This is no guarantee that I won't get cancer tomorrow - I'm not that naive and I'm not looking it like that. I might not know everything I'm supposed to avoid or everything I'm supposed to do, but we have enough knowledge right now to at least do something.

That is quite frankly a horrible attitude and I really hope you don't share that with your patients.

Do you honestly think that years and years of drinking, smoking, doing drugs, neglecting exercise, and eating a horrible diet help your chances in terms of preventing cancer?

If this is what doctors are telling their patients, it's no wonder why 50% of people in Canada die of preventable causes and the country is so obese and unhealthy. Hey, "we're pretty much screwed anyway." right? Who cares about taking care of yourself? Oh well, me for one, but you can go ahead and do what you want. I do sincerely feel sorry for anyone who you give this advice to though. Why the pessimism Jane? I thought you were one of the most optimistic people I know but I guess I was wrong.

Luckily I have a forum where I will reach a lot of people with my opinions - and I certainly won't be telling everyone what you said. Maybe you would do well to learn about self fulfilling prophecies. They are extremely powerful.

And as for cancer - forget about cancer for a second. First off, I disagree with you anyway, but even if I were to take your attitude that there's no preventing it there are still dozens of other chronic diseases we know much more about and should try to prevent.

One day when you will get caught up with being swamped with patients and work due to people's self abusive neglect and stupidity you will wish that more people in this country had my attitude. You just wait and see.

If it makes you feel any better, go re-read this post and replace "cancer" with "heart disease" or "diabetes" or another chronic illness. I certainly hope you would look at this post as a positive one, as I would expect any doctor to.

Quote:"to pretend cancer is just some random shot in the dark in every single case - yes it obviously is for a minority of individuals, but for many, the pathology can be clearly traced."

Minority? Really? And you are basing your statement on what data? I'd invite you to spend one day at Princess Margaret Hospital, Canada's leading cancer hospital, and tell me how many times you you can clearly trace the pathology. Then take a similar population from outside the hospital matched for age, sex, and exposure to what you think is the causative agent, and see how many of them actually develop cancer.

Sure, you are right in the sense that, before I cross a street, even though I know that there's a chance of getting hit by a car every time no matter what I do, I still choose to look both ways. The same thing goes for health and cancer prevention. There's really no sense in throwing yourself out in front of a car and hoping that you live (i.e., smoking and hoping that no cancer develops). But there is always the unpredictable. And unlike my car analogy, when it comes to cancer, the great majority of risks are unknow and/or unpredictable and/or uncontrollable.

This doesn't, mean that you shouldn't try. But I don't think that it would be a good idea to divert much more money from finding cures into prevention, simply because people know what to do and what not to do in order to be healthy and stay a bit farther away from cancer. The sad reality is that no amount of money or fancy campaigns will make people change unless they want to change. The information is out there. A portion of the public is simply choosing not to acknowledge it.

I didn't say that for the majority the pathology could be clearly traced, but many. I know that not all cancer takes the form of a direct relationship like lung cancer caused by smoking. Age is also a risk factor, so anyone over the age of 55, whether seemingly perfectly healthy or not, is at a greater risk than someone my age. Unless you are saying that a large portion of people who get cancer (1) show no family history, (2) have a healthy lifestyle, diet and so on. Unless I've been taught lies, cancer solely as a probabilistic process is not what most cases of cancer are. Like I said, there is much we don't know, but much we do know. The gaps don't make our current knowledge unimportant or anything. I don't think we disagree on this anyway.

You say that the majority of risks are unknown, unpredictable, or uncontrollable. I would say the majority of risks are genetic. After all, how does my grandfather live as long as he did drinking far more than others who would have been long dead from liver cancer by now? All else equal, genetics make the difference.

For example, I doubt that anyone my age who died of leukemia was exposed to a risk factor that I haven't been. Now I'm making cancer out to be uncontrollable (e.g., genetic).

I'm curious if you agree with me that if everyone did follow lifestyle and diet choices which are known to prevent cancer, that there would be less cancer? And for that matter - far less?

Now in your last paragraph, you seem to reject my hypothesis on practical grounds. I guess I can't really argue that. In reality - people may not be ignorant, but simply uncaring. What can you do? Find a magical pill, I guess. But although I do believe the information is out there, I know that (for me at least), it's something I have had to seek and be extremely proactive about. Our culture is all about being spoonfed - I say, spoonfeed us the prevention science. Surely, that will get some kind of response.

FYI, I'm not against money being spent on a cure, but I'm in favour of anything which will increase health discipline. Maybe it is being naive, but I have faith that that is possible.

After spending a while day dealing with families of patients who "know better" even though they don't have any medical training beside some first aid courses, what their 69 year old family doctor told them, and what they think they understood from the internet, I am obviously in a rather impatient mood. So, I'll end this discussion prematurely because I am not in a mood to keep arguing with you. It's obvious that you place an inordinate amount of importance on genetics as you said yourself in your initial post, referring to the diathesis-stress model. While I will not argue the importance of genetics, I will say that I find your "genetics makes the difference" argument is short-sighted and uninformed. But as I don't feel like arguing or explaining any further, especially in the context of someone who is already convinced of the truth of his hypothesis, I'll just say that you win this argument and get myself to bed, so that I can deal with the exact same mentality tomorrow morning when I report for work.

This was not really the reply I expected, mainly because I wasn't trying to argue anything at all, in fact, I thought my reply was a step closer for us to see eye-to-eye. It was just a statement of opinion. I just re-read what I wrote to make sure I wasn't coming across as if I was disagreeing with you, and I still don't think I was. For instance, (1) in paragraph one, I agreed with you that not every cancer has a clearly traceable cause-effect relationship, (2) in paragraph four, I asked if you agreed that prevention is very beneficial, alluding to the fact that I feel it is, (3) in paragraph five I went on to agree that prevention may not be practical, but stuck with my belief that we would be better off if we all did apply the basic principles of prevention.

As for disagreements (also clearly expressed as my opinion and not statement of fact), (1) in paragraph two, I stated that I felt genetic factors are more important than unknown, unpredictable, and uncontrollable ones. I ended that paragraph with "All else equal, genetics make the difference." The first half of that sentence is fundamental to the second part. Without the first part, the second falls apart.

I count one single disagreement, and some admittance to ignorance along with questions.

I will also say that a lot of the way I feel is based on what I've learned. What I've learned may be wrong or different than what you've learned - I don't know, but I would suspect that isn't the case. A lot of what I've learned was not from the medical community, but the words of optimistic health psychologists. Our differing perspectives may be epistemological in nature. I actually think you and I agree more than any of this discussion is making it seem like. I do believe you feel that prevention is as important as I feel it is. I also know that cancer can be as unavoidable as you make it out to be. I think our main disagreement is that you feel that people are informed but uncaring, while I would tend to think people are somewhat unimformed, so my model of money-for-prevention falls apart on practical grounds, as you feel money for a cure would be money more appropriately spent. So what this equates to is me clinging to the belief that more awareness will help, when you feel that the awareness is out there but that people choose to ignore it? Forgive me for speaking on your behalf, but do you feel that people do have the knowledge, but are lacking the emotional discipline to apply it? I think in that case, a better response to me would be to call me naive. After all, from your comments, you do agree that prevention is important, but acknowledge that, realistically, people opt to avoid it.

Now don't get me wrong, I'm all in favour of debating (or "arguing"), but I would barely call our discourse a debate. Just an exchange of opinions. I'm not trying to sell my opinions as fact, and going over this whole thread, I don't think I did.

The whole idea of livejournals to chat with people you know in real life is to me, a waste of time. But chatting with you on here is valuable to me because I don't know you in person. I respect you, Jane, for being a decent person. You are decent because you are kind to people every day and that is why I like to maintain contact with you online. If you were a friend of mine in real life, I would sort this out with you in person, but in this case, that option isn't available.

Bearing in mind I never said that I was completely sure of anything, and where possible confessed my ignorance, I hope that you don't consider me the type of patient who thinks he knows better. Because I would hate to come across that way when it isn't at all how I feel.

I also would like to make a few more points on this:

You are obviously familiar that many people with treatable diseases including various cancers cannot even be bothered to take their chemotherapy drugs or medication to begin with. This attitude simply needs to change. Even when treatments and cures are available, the attitudes we've learned prevent us from using them in many cases. People aren't emotionally undisciplined by nature - we are taught indolence at an early age. It is then natural that we remain indolent. This needs to change. We need to teach new ways. My prevention model is all about taking charge and being held accountable for ourselves.

Also bear in mind that part of putting money towards preventative measures also includes putting money towards identifying the carcinogens and what to avoid. You say we don't know what to avoid - under the prevention model, these would be identified.

Regarding genetics: I breathed the same air as a person I knew who died of leukemia at my age. I drank the same water. I ate the same food. I seem to doubt that he came in contact with a mysterious carcinogen that I just luckily missed out on. I seem to think you are downplaying genetics. I know it's depressing to learn that something so uncontrollable is also so powerful - I don't like it either, but I've learned to accept it. It's the same reason why a human being has the lifespan of about 70-80 years where a dog might have the lifespan of 20 - genetics. My dog could eat healthy food, take medicine when needed, live a healthy life - my dog won't live to 23 regardless of what she does. That's genetic. Same reason why Arnold gained so much more muscle than me. We do the same workouts, eat the same food - all he has in addition to this is a few methandrostenolone pills a day and superior genetics. Genetics go a long way. I had a hard time accepting this and I still don't like it, but I believe it's true. A person would be hard pressed to convince me otherwise.

A cure is necessary in my opinion - for those who have a strong genetic predisposition and other unfortunate people. But in general, our continent's decadent attitude needs to change. This may be idealist of me, but I honestly feel that way.

If you don't like my attitude, you would really hate the stuff psychologists teach students. A patient who storms into your office and demands a certain prescription is not the same as one who discusses and exchanges ideas with a physician. My doctor loves it. He appreciates my consiceness and interest in being proactive about his own health. Interestly enough, as a result of my efforts I'm not in his office all that much, which is another bonus for him.

Cancer cures, unfortunately, leave much to be desired. I have little faith in them. So rather than sit and wait and hope, I'll exercise regularly, eat a healthy diet, minimize my stress levels, and lead a healthy, happy life. If I die of cancer, so be it. But I won't go down calmly if it comes to that, that's for sure. I'll continue to do what I do and reap the health rewards that come with it. They've worked this long, and I have every intention of continuing with them. Other people are free to do what they wish, and if they have faith cancer will be cured before they get it - fine. But I have more faith in myself than such research.

Quote:"But I don't think that it would be a good idea to divert much more money from finding cures into prevention, simply because people know what to do and what not to do in order to be healthy and stay a bit farther away from cancer."

I think it would be an excellent idea so that we can kill this bullshit attitude at the root.

You do realize that 50% of people die of preventable causes right? With a lot of the other half dying of natural causes, how many of the remainder are truly deserving of a cure? The people who couldn't do anything to prevent their death - not many.

Someone once said to me: "I believe there will be a cure for cancer by the time that I get it." Spoken with confidence too.

We need to eliminate this disgusting attitude from our society. Get it?

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